STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

Date of Institution: 28.03.2018

                                                         Date of final hearing: 10.05.2023

Date of pronouncement: 21.06.2023

First Appeal No.384 of 2018

IN THE MATTER OF:

Mahender Kumar Aggarwal son of Sh. Siri Chand Aggarwal, resident of near Siri Ram Dharam Kanta, Railway Road, Bye Pass, Hodel, District Palwal.                                                                           …..Appellant

Versus

1.  M/s Oriental Insurance Company Limited, Branch Office First Floor, Sector-1, Manesar, Gurgaon Tehsil and District Gurgaon, Service be effected at its Local office through its branch Manager Kalra Colony, Old G.T. Road, Palwal Tehsil and District Palwal.
2. Oriental Bank of Commerce, Hodal, Tehsil Hodal, District Palwal, service be effected through its Branch Manager.
3. M/s Medi-Assist India Pvt. Ltd. Service be effected through the Branch Manager, Oriental Insurance Company Ltd. Palwal, District Palwal.                                                   …..Respondents

CORAM:              Naresh Katyal, Judicial Member

Argued by:-       None for the appellant.

Ms. Swatantar Kapoor, counsel for respondent No. 1 & 3.

Sh. Anup Prajapati, proxy counsel for Sh. Pancham Sharma, counsel for respondent No. 2.

                                                ORDER

NARESH KATYAL, JUDICIAL MEMBER:

          Delay of 181 days in filing of appeal stand condoned for the reasons stated in the application for condonation of delay.

2.      Appellant herein, having being successful, before District Consumer Disputes Redressal Forum-Palwal (In short “District Commission”), still has invited challenge to the legality of order dated 29.08.2017 passed by District Consumer Commission in complaint No.49 of 2017.

3.      Appellant had procured Medi-claim policy from OP No. which has validity from 18.02.2016 to 17.02.2017. On 01.11.2018, he fell ill. He was having complaint of Giddiness followed syncope. He got treatment in Life Care Hospital-Hodal. There was no improvement. He was hospitalized in QRG Central Hospital and Research Centre, Faridabad on 03.11.2016 and remained there till 09.11.2016. He was diagnosed with Dengue like illness with severe thrombocytopenia/transaminitis. He had incurred expenses of Rs.1,29,450/- on his treatment (medicines, tests, hospitalization) from 01.11.2016 to 21.11.2016. He intimated regarding his admission and treatment to OP No. 1, on 04.11.2016 which issued cashless claim No. 13504762. On next day i.e. on 05.11.2016 his claim was declined on pretext that two years waiting period for HTN has not completed. Basically, on this grievance he filed complaint by asserting negligence, insufficient service and unfair trade practice on the part of OP. He has sought directions against OP to pay him Rs.1,29,405/- with future expenses and interest @ 18% p.a. till realization; compensate him for Rs.50,000/- due to mental agony and sufferings and pay him litigation expenses to the tune of Rs.15,000/-.

4.      Upon notice, OPs raised contest. In defence, OPs No. 1 & 3 have taken plea regarding non-maintainability of complaint, no locus standi and cause of action in favour of complainant, forum has no jurisdiction and complaint being based upon false and frivolous grounds. On merits, in para no. 3, thereof, it is pleaded that expenses of Rs.1,29,450/- incurred by complainant on his treatment is a matter of record. It has been denied that treatment of complainant is going on. It is pleaded that complainant is not entitled any amount from OPs No. 1 & 3.

5.      OP No. 2 Oriental Bank of Commerce-Hodel, in its separate reply has pleaded that it has been unnecessary dragged in the complaint. It is pleaded that illness and treatment relate to complainant and OPs No. 1 & 3. OP No. 2 has no knowledge about the same. Dispute is between complainant and OPs No. 1 & 3. There is no deficiency in service of OP No. 2. There is no question of any reimbursement by OP No. 2. Complainant has no cause of action against OP No. 2 (Bank).

6.      Parties to this lis led evidence, oral as well as documentary before learned District Consumer Commission.

7.      After critically analyzing the evidence, learned District Consumer Commission has accepted and allowed the complaint. Directions has been issued to OP No.1 (Oriental Insurance Company) to pay Rs.1,00,000/- with 9% interest from the date of repudiation of claim till its realization; pay compensation of Rs.20,000/- to complainant and pay litigation expenses of Rs.5500/-. OP No. 1 Oriental Insurance Company Ltd., has been directed to comply with directions within 45 days from date of order, failing which it will be burdened further to tune of Rs.20,000/- as compensation in addition to compensation amount awarded(Rs.1,00,000/-).

8.      OP No. 1 (insurer), being aggrieved has not challenged the order dated 29.08.2017 by filing any appeal. However, complainant has filed this appeal claiming enhancement of compensation by alleging therein, that learned District Commission has grossly erred in law, in not awarding compensation as claimed.  It is urged that Medical bills are of the amount of Rs.1,29,405/-. Less compensation has been awarded to complainant for mental pain.

9.      On behalf of OPs No. 1 & 3, it has been urged that adequate compensation has already been awarded passed by learned District Consumer Commission. Zimni order dated 09.04.2019 passed by this Commission indicates that Rs.1,29,250/- have been paid by OPs No. 1 & 3. This amount include: Rs.1,00,000/- being actually awarded and Rs.29,250/- being interest at the rate of 9% per-annum. Claim Settlement advice in this regard has been placed on record.

10.    This Commission does not see any justifiable reason to further enhance compensation amount, already awarded in favour of complainant/appellant. Endeavour of the learned District Consumer Commission has been to award just compensation to complainant and this Endeavour has been fulfilled, with earnest. The complainant did suffered ailments which led him to remain hospitalized from 03.11.2016 to 09.11.2016. Obviously, indoor hospitalization for about a week, must had added to the complainant’s tale of woes. Annexure C-11 is the bill of amount of Rs.1,29,405/- and this is amount, so claimed by complainant by filing complaint. In firm opinion of this Commission; learned District Consumer Commission has adopted rational pragmatic approach to the cause, and awarded just compensation to the tune of Rs.1,00,000/- with 9% interest since the date of repudiation of claim, till its realization. In considered opinion of this Commission; no further enhancement of compensation is tenable.  In any case, learned counsel for the appellant could not put across this Commission, with any tangible evidence, warranting enhancement in compensation, even on principle of equity. Impugned Order dated 29.08.2017, is the outcome of proper appreciation of evidence and hence it is maintained and affirmed. Consequently, this appeal does not carry any substance. It is accordingly dismissed.

11.    Application(s) pending, if any stand disposed of in terms of the aforesaid judgment.

12.    Copy of this judgment be provided to parties, free of cost as mandated by the Consumer Protection Act, 1986/2019. The judgment be uploaded forthwith on the website of the Commission for the perusal of the parties.

13.    File be consigned to record room.

Date of pronouncement: 21^st June, 2023

                                                                                       Naresh Katyal                                                                                          Judicial Member

Addl. Bench-II